Ventilator-Associated Pneumonia and PaO2/FIO2 Diagnostic Accuracy: Changing the Paradigm?

BACKGROUND: Ventilator-associated pneumonia (VAP) is associated to longer stay and poor outcomes. Lacking definitive diagnostic criteria, worsening gas exchange assessed by PaO2/FIO2 ≤ 240 in mmHg has been proposed as one of the diagnostic criteria for VAP. We aim to assess the adequacy of PaO2/FIO2 ≤ 240 to diagnose VAP. METHODS: Prospective observational study in 255 consecutive patients with suspected VAP, clustered according to PaO2/FIO2 ≤ 240 vs. > 240 at pneumonia onset. The primary analysis was the association between PaO2/FIO2 ≤ 240 and quantitative microbiologic confirmation of pneumonia, the most reliable diagnostic gold-standard. RESULTS: Mean PaO2/FIO2 at VAP onset was 195 ± 82; 171 (67%) cases had PaO2/FIO2 ≤ 240. Patients with PaO2/FIO2 ≤ 240 had a lower APACHE-II score at ICU admission; however, at pneumonia onset they had higher CPIS, SOFA score, acute respiratory distress syndrome criteria and incidence of shock, and less microbiological confirmation of pneumonia (117, 69% vs. 71, 85%, p = 0.008), compared to patients with PaO2/FIO2 > 240. In multivariate logistic regression, PaO2/FIO2 ≤ 240 was independently associated with less microbiological confirmation (adjusted odds-ratio 0.37, 95% confidence interval 0.15-0.89, p = 0.027). The association between PaO2/FIO2 and microbiological confirmation of VAP was poor, with an area under the ROC curve 0.645. Initial non-response to treatment and length of stay were similar between both groups, while hospital mortality was higher in patients with PaO2/FIO2 ≤ 240. CONCLUSION: Adding PaO2/FIO2 ratio ≤ 240 to the clinical and radiographic criteria does not help in the diagnosis of VAP. PaO2/FIO2 ratio > 240 does not exclude this infection. Using this threshold may underestimate the incidence of VAP.info:eu-repo/semantics/publishedVersio

Differences in salivary α-amylase levels among women with different taste sensitivities

Saliva is the main component of taste receptor cells external environment, and consequently it may have a decisive role in taste perception. Taste sensitivity varies among different individuals. Sensitivity to the compound n-6-propylthiouracil (PROP) has been considerably studied and besides the known influence of genetic background, the contribution of perireceptor environment is not completely clear yet. Salivary α-amylase (one of the main proteins of saliva) is involved in carbohydrate digestion and its enzymatic activity may change the levels of sugars present in the mouth, influencing food perception. To evaluate differences in salivary total protein content and α-amylase activity and expression among individuals with different PROP taste sensitivities. Sixty seven female women (18-30 years old) were classified in one of the three groups of taste sensitivity (non-taster, medium-taster or super-taster), according to the perceived intensity for PROP, using Labeled Magnitude Scales. Saliva was collected without stimulation. Flow rate was calculated by dividing total volume for the 5 minutes collection. Bradford method was used for total protein assessment. Dinitrosalicylic acid assay was used for measuring the starch-hydrolyzing activity of salivary α-amylase, while the expression of this enzyme was evaluated by Wester blot. 20,9% of the subjects were classified as non-taters. The three groups presented similar saliva flow rates and total protein content was not significantly different although a tendency for lower protein concentration in medium-tasters individuals was observed. Salivary α-amylase activity (U/min) was higher in supertasters (P<0,05). Salivary α-amylase activity (U/min) was higher in super-tasters (P<0,05) without any significant differences in expression. In women individual differences in saliva composition can contribute to the different taste sensitivity. One of the differences appears to be α-amylase enzymatic activity. The reason for this deserves to be elucidated, as well as the potential involvement of others salivary proteins

Variscan deformation of the Hesperian massif in the Lousã mountain range (central Portugal)

[Abstract] The occidental region of the Central-Iberian Zone of the Variscan Iberian massif, in the central part of Portugal (Lousã mountain range), has a Variscan tectonostructural organization as the one recognized in the occidental border of the massif, in the Porto-Coimbra-Tomar shear zone. In the Iberian massif we can observe neo-proterozoic metasediments of the “Complexo Xisto-Grauváquico”, and important metasedimentary outcrops of Late Palaeozoic (Ordovician, Silurian and lower Devonian) rocks. Both are affected by the first regional variscan deformation phase (FH1), and later refolded by the second variscan deformation phase (FH2). This second regional variscan phase has a penetrative effect in the massif and develops a dextral, north-south, strike-slip faulting, associated with transpressive kinematic deformation (like a Riedel model) similar to the Porto-Coimbra-Tomar shear zone. Some geological examples observed and studied in the Lousã region are showed and discussed

Electrochemical characterization of poly(ethylene oxide)- zinc chloride system and its application in rechargeable batteries

The system PEOnZnCl2 with n=4-16 was studied in view of its potential application in a solid state rechargeable zinc battery. A.c. conductivity and cationic transference number measurements, in the temperature range 20-150ºC, were performed and the electrochemical stability window was established for the polymer electrolyte with n=4 composition. The ionic conductivity, σ, of this film, follows a VTF behaviour, with an activation energy of 3.3 ± 0.2 kJ mol-1 and σ values were found between 2.50x10-7 S cm-1 at 24ºC and 4.81x10-4 S cm-1 at 145ºC. Acceptable zinc ion transference numbers of 0.36 (medium value) and decomposition voltage values between 3.19V (20ºC) and 1.44V (150ºC) were estimated. Cyclic voltammetric studies using Zn/PEO4ZnCl2/Zn cell indicated reversibility of the Zn/Zn2+ couple at the electrode/electrolyte interface. Several cells Zn(-)/PEO4ZnCl2/Nb2O5(+) were assembled and studied at 55ºC, with several discharge current densities. Results of cell’s discharge profiles, capacity values, charge-discharge cycles behaviour and stability are reported

Population decline in the critically endangered Musschia isambertoi (Campanulaceae) endemic to Desertas Islands (Madeira Archipelago) calls for urgent conservation management

Macaronesian islands display a high degree of plant endemicity and correspond to some of the most threatened biodiversity hotspots due to several human driven impacts such as habitat loss, invasive species, overexploitation or climate change. The conservation status of the largest of the two known population of Musschia isambertoi M. Seq., R. Jardim, Magda Silva and L. Carvalho (Campanulaceae) was assessed recently. Field work was done in June 2018 in “Porto das Moças” Deserta Grande (Madeira Archipelago, Portugal), the locus typicus, where in 2006 close to 30 plants were detected with a high variation of age/size between individuals comprising both fully flowering and non-flowering adult plants as well as seedlings, and thus corresponding to a healthy population. This study assesses population size, age and plant size, and genetic, as well as floristic diversity. The total area of the site corresponds to approximately 1500 square meters. Ten individuals were detected, all corresponding to young seedlings not exceeding 15 cm high, and exhibiting approximately the same size and numbers of leaves (4–8). No adult plants or remains of adult plants were seen. Ecological data and direct herbivory evidence suggest that perennial plants are subjected to elimination during the short summer by the feral goat population. Mo lecular data based on ISSR markers show that the nine sampled individuals (out of ten individuals found) are genetically identical, possibly resulting from one parental plant. Results clearly suggest that Musschia isambertoi is very close to extinction. Urgent conservation measures are imperative and should include the immediate fencing of the population followed by the elimination of feral goats from Deserta Grande. The elimination of feral goats was initiated in 1996 (LIFE95 NAT/P/000125, 383,467.00 €) but stopped due to inappropriate conser vation policies of the former Services of the Natural Park of Madeira.info:eu-repo/semantics/publishedVersio

Produção de mudas de Ipomoea acuminata (Vahl) Roem. & Schult. por estaquia: resultados preliminares.

Organizado por Patricia Póvoa de Mattos, Celso Garcia Auer, Rejane Stumpf Sberze, Katia Regina Pichelli e Paulo César Botosso

Fluorescence in nanostructured fulleride films

Applied Physics Letters, 89Nanostructuring of fullerene C60 beam deposited films is achieved by electrochemical reduction in a potassium hydroxide aqueous solution. Alkali fulleride clusters are formed at the electrode, as it is illustrated by cyclic voltammetry, x-ray diffraction, and scanning tunneling microscopy. Fluorescence emission from fluorophore doped fullerene reduced films was investigated by fluorescence spectroscopy and scanning near-field optical microscopy. These techniques lead to results which also fit such nanometer-sized fulleride cluster interpretation. In particular, the fluorophore fluorescence lifetime decreases as long as aggregation in the film is more effective,which occurs with the increase of film thickness

Live-captures of common bottlenose dolphins <i>Tursiops truncatus</i> and unassessed bycatch in Cuban waters: evidence of sustainability found wanting

In the period 1986-2004, 238 common bottlenose dolphins Tursiops truncatus were exported from Cuba, as shown by UNEP/WCMC data, more than 60% of these to facilities in Latin America and the Caribbean, some 32% to Europe and the rest to Canada and Israel. There is a very significant increase in exported numbers, reaching 28 individuals per annum in 2002. It is unclear how many T. truncatus have been used in domestic dolphinaria. A review of available information did not identify evidence to corroborate hypotheses that: (i) T. truncatus off Sabana-Camagüey Archipelago (where removals occur) does not show population structure; and (ii) virtually no bycatches occur in Cuban waters. Here it is argued that, considering Cuba's fully developed marine fisheries, some level of mortality from bycatch is inevitable. Other potential threats are also identified. Global phylogenetics research of T. truncatus is revealing unexpected and more complex, stock structures, in inshore (coastal) forms within relatively small areas. In Cuba, low mean group sizes (less than 10) suggest that one or more coastal stock(s) are exploited. Sex distribution of measured specimens suggest a significant bias towards extraction of females. It is concluded that sustainability of harvest levels of Cuban T. truncatus cannot be evaluated until abundance estimates become available and population structure is verified by molecular genetic methods. Pérez-Cao (2004) indicated that available density estimates should not be used to determine [safe] catch quotas. The authors strongly recommend that international trade of T. truncatus from Cuba ceases until no-detriment can be authenticated and that more research be developed. Similar arguments may be applicable to other unassessed but exploited populations in the Wider Caribbean

Future Distribution of Suitable Habitat for Pelagic Sharks in Australia Under Climate Change Models.

Global oceans are absorbing over 90% of the heat trapped in our atmosphere due to accumulated anthropogenic greenhouse gases, resulting in increasing ocean temperatures. Such changes may influence marine ectotherms, such as sharks, as their body temperature concurrently increases toward their upper thermal limits. Sharks are high trophic level predators that play a key role in the regulation of ecosystem structure and health. Because many sharks are already threatened, it is especially important to understand the impact of climate change on these species. We used shark occurrence records collected by commercial fisheries within the Australian continental Exclusive Economic Zone (EEZ) to predict changes in future (2050-2099) relative to current (1956-2005) habitat suitability for pelagic sharks based on an ensemble of climate models and emission scenarios. Our predictive models indicate that future sea temperatures are likely to shift the location of suitable shark habitat within the Australian EEZ. On average, suitable habitat is predicted to decrease within the EEZ for requiem and increase for mackerel sharks, however, the direction and severity of change was highly influenced by the choice of climate model. Our results indicate the need to consider climate change scenarios as part of future shark management and suggest that more broad -scale studies are needed for these pelagic species